Smile In Action - how can we help?

We all need a helping hand from time to time, especially in tough times like these.

Whether it’s a friend, a loved one, a family member, someone you know of, or yourself, who is struggling or going through a crisis and don’t know how to get through it… we want to help.

Do any of the below situations apply to you or someone you know?

Do you need care or assistance with a medical condition?

Assistance with a medical condition

Name

First

Last

Phone

Address

City

State/Province

Zip/Postal

Country

What medical condition have you been diagnosed with?

Have you consulted a doctor and what was the prognosis?

How can we provide assistance?

I confirm that all the information provided is accurate and true.

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If you are human, leave this field blank.

Are you struggling to find employment or getting your own business off the ground?

Struggling to find employment

Name

First

Last

Phone

Address

City

State/Province

Zip/Postal

Country

Do you have your own business or are you looking for employment?

What is your area of expertise?

What is your highest qualification?

What is the challenge you would like us to help you with?

I confirm that all the information provided is accurate and true. *

If you are human, leave this field blank.

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Have you always wanted to study further or complete your studies, but never had the opportunity?

Study further

Name

First

Last

Phone

Address

City

State/Province

Zip/Postal

Country

What is your highest qualification?

What is your ideal institution to study at?

What would you like to study?

What's been preventing you from studying further?

I confirm that all the information provided is accurate and true. *

If you are human, leave this field blank.

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Are you a single parent, or do you know of a single parent that is struggling to make ends meet?

Single parent

Name

First

Last

Phone

Address

City

State/Province

Zip/Postal

Country

Are you a single parent struggling to make ends meet or are you looking to help someone you know?

Tell us about your/their challenges

How would you like for us to assist?

I confirm that all the information provided is accurate and true. *

If you are human, leave this field blank.

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Are you currently going through a tough time in your relationship?

Tough time in long term relationship

Name

First

Last

Phone

Address

City

State/Province

Zip/Postal

Country

How long have you been in a relationship with your partner?

What is the problem you are currently experiencing?

How do you suggest we get involved?

I confirm that all the information provided is accurate and true. *

If you are human, leave this field blank.

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Have you lost contact with a family member or a loved one?

Lost contact with a family member

Name

First

Last

Phone

Address

City

State/Province

Zip/Postal

Country

Who is the person you're trying to locate and how are they related to you?

When did you lose contact with them?

What have you done so far to try and locate them?

Why is it important to you to be reunited with them?

I confirm that all the information provided is accurate and true. *

If you are human, leave this field blank.

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Have you hit a 'road block' that is seriously holding you back in life?

Red Flag

Name

First

Last

Phone

Address

City

State/Province

Zip/Postal

Country

What is holding you back in life?

How long have you been experiencing this problem?

Why is it hindering you?

How do you suggest we help you?

I confirm that all the information provided is accurate and true. *

If you are human, leave this field blank.

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Are you experiencing any personal challenges not listed above? Tell us more.

Personal challenges

Name

First

Last

Phone

Address

City

State/Province

Zip/Postal

Country

Describe the challenges you're facing in detail.

How do you suggest we help you?

I confirm that all the information provided is accurate and true. *

If you are human, leave this field blank.

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